Fine needle aspiration cytology is being commonly used for initial diagnoses of oral cavity and oropharyngeal lesions. The aim of this study was to assess the role of Fine Needle aspiration cytology in diagnosis of intraoral and oropharyngeal lesions and to compare with histopathological findings in those cases which underwent biopsy examination. This is a tertiary care center based retrospective study done over a period of two years. Out of total 660 fine needle aspiration cytology in two years; 133 cases were of oral and oropharyngeal region. 54 were male and 79 were of female. Frequently involved site was tongue (n=45). Predominant non neoplastic cases were of chronic inflammation (n=43) and neoplastic cases of squamous papilloma (n=15). Among neoplastic cases most common malignant cases were of squamous cell carcinoma (n=4). Sensitivity of the FNAC method was found to be 80% and specificity was identified as 100% comparing with gold standard histopathological examination. No significant complications were seen in patients undergoing these FNAs. It can be concluded that FNA is a simple and rapid diagnostic test that can be useful for preliminary assessment of oral and oropharyngeal lesion.
A 40-year-old heterosexual Zimbabwean man was admitted to hospital with a pyrexial illness. Serology on presentation included C-reactive protein of 82 mg/l and haemoglobin of 11.3g/dl. His total and differential white cell counts were within the normal range. A chest X-ray was normal.As part of the investigative work-up for pyrexia of unknown origin, a computed tomography (CT) scan of the thorax, abdomen and pelvis was performed. This revealed widespread para-aortic lymphadenopathy and enlarged nodes in the left iliac fossa. Additional history was notable for weight loss and drenching night sweats over the preceding weeks.An antibody test for human immunodeficiency virus (HIV) was positive, and HLA B5701 was negative. Baseline CD4 count was 265 cells/mm 3 and HIV RNA viral load was 444,000 copies/ml. Highly active antiretroviral therapy (HAART) was commenced in the form of abacavir/lamivudine and efavirenz.Working diagnoses at this stage included HIV-related reactive lymphadenopathy, mycobacterial (atypical or tuberculous) infection and neoplastic disorders.Despite repeatedly negative investigations for tuberculosis (TB), including sputum, early morning urine samples and a gamma interferon release assay (T-spot TB), the patient was commenced on anti-tuberculous therapy as his presenting picture was consistent with TB.A para-aortic lymph node was biopsied under CT control. Histology was consistent with reactive hyperplasia. There was no evidence of TB. Symptoms began to resolve over the subsequent few weeks and the patient tolerated anti-tuberculous therapy well.Four months later he presented with recurrence of fever and night sweats, now in conjunction with epigastric pain and diarrhoea. He reported weight loss of 10 kg in the preceding six weeks. A repeat CT scan revealed further enlargement of the para-aortic lymph nodes and now a large lymph nodular mass in the left pelvis and lower abdomen.An ultrasound-guided biopsy was obtained from this mass. Immunohistochemical staining of the biopsy revealed a number of bi-and multi-lobar cells strongly positive for Epstein-Barr virus (EBV), CD15 and CD30. Staining for leucocyte-common antigen and human herpes virus 8 was negative. Ziehl-Neelsen stain was also negative.These histological features are consistent with the Reed-Sternberg malignant cell (Figure 1), diagnostic of classical Hodgkin's disease. A subsequent bone marrow aspirate revealed no infiltration.The importance of pursuing a histological diagnosis in the HIV setting aBstRaCt A 40-year-old heterosexual African man was admitted with fever, night sweats and lymphadenopathy. His human immunodeficiency virus antibody test was positive. Initial lymph node biopsy revealed reactive hyperplasia only. He was empirically treated for tuberculosis. However, symptoms persisted and a repeat lymph node biopsy was obtained, which confirmed Hodgkin's disease. This emphasises the need to pursue histological diagnosis in such patients with persisting symptoms.
Head and neck region chondrosarcomas are very rare accounting for 1-12 % of all chondrosarcomas.1 Thoracic spine is commonly affected. We here present a rare case of upper cervical spine chondrosarcoma in a pediatric patient.A 7-year-old boy presented with painless and slowgrowing mass in the left posterior cervical region. He had no neurological defi cits. Computed tomographic scan showed hypodense, non-enhancing lesion in left posterior cervical region abutting posterior arch of C1. It also contained calcifi cation. Magnetic resonance imaging revealed hypointense lesion on T1-and hyperintenseon T2-weighted and STIR images, with slight extension into the neural foramina without widening it ( Figure 1). Peripheral nerve sheath tumor was suspected and the patient underwent total resection of the lesion. Left vertebral artery was abutting the lesion anteriorly without encasement.The nodular, grayish to whitish, 3.8 cm x 2.4 cm mass was removed (Figure 2) with hyaline matrix. Chondrocytes were hypercellular with rare binucleate chondrocytes with mild nuclear pleomorphism (Figure 3). These fi ndings are suggestive of low-grade (grade I) chondrosarcoma. The patient had no postoperative defi cits and regular follow-up was advised considering high recurrence rate.En-bloc resection remains the choice for chondrosarcomas. Local recurrence is very common.
Introduction: Extrapulmonary tuberculosis is equally important as that of pulmonary tuberculosis. Fine needle aspiration cytology (FNAC) is accurate, cost effective, minimal invasive outpatient procedure and aids in prompt diagnosis of extrapulmonary tuberculosis. Aims: To determine the role of fine needle aspiration cytology for diagnosis of extra pulmonary tuberculosis. Methods: This is a hospital based descriptive study done over a period of one and half year April 2019 to October 2020 at Nepalgunj Medical College Teaching Hospital, Nepalgunj, Nepal. All the 80 patients who were clinically suspected for tuberculosis had undergone fine needle aspiration cytology and diagnosed as tuberculosis in cytology were included in study. Cytological diagnosis was made with microscopic features and positive acid fast bacilli staining. Microscopy showed epithelioid histiocytes, granulomas, multinucleated giant cells, caseous necrosis, neutrophils and mature lymphocytes. Results: Out of 930 cases received, 80 cases were diagnosed as tuberculosis in cytology. 33 cases were diagnosed with acid fast bacilli positive. Rest was diagnosed with cytological features. Among 80 aspirated samples, a portion of purulent specimen was evaluated with Genexpert test in 11 cases for Mycobacterium Tuberculosis detection and rifampicin sensitivity/ resistant. Out of 11 positive patients in Genexpert tests; 10 were rifampicin sensitive and one was rifampicin resistant. Conclusion: Common presentation of extrapulmonary tuberculosis is in lymph nodes with increased frequency in age group of 21 to 30 years. Therefore, lymph nodes in this age group should be prioritized more for investigation of extrapulmonary tuberculosis.
Introduction: Bronchoalveolar lavage has a high diagnostic utility for cytology and bacteriology. It can be done as an outpatient procedure for both immunocompetent and immunocompromised patient. Material obtained by bronchoalveolar lavage can give a definite diagnosis in conditions such as infections and malignancies. Aim: The aim of this study was to assess the diagnostic value of bronchoalveolar lavage (BAL) in cases which underwent routine bronchoscopy for evaluation of lung disease. Materials and methods This is a hospital based descriptive study done from 16th June 2016 to 15th June 2017. One hundred twenty bronchoalveolar lavage (BAL) cases were analyzed for differential count, cytological evaluation and bacteriological examination. All cases were included which were sent as BAL specimen to the laboratory department. Bronchoscopy was done as an outpatient procedure and lavage fluid obtained was analyzed. Result: Out of 120 cases, 69 were male and 51 were female. The age ranged from 10 to 80 years. Among 120 cases, eight (n= 6.66%) cases were unsatisfactory, twelve (n= 10%) cases were of tuberculosis, one (n= 0.83%) case was of fungal infection, two (n= 1.67%) cases were of malignancy, ninety one (n= 75.84%) cases were of small airway infection and six cases were satisfactory but with no diagnostic value. (n= 5%). Conclusion Bronchoalveolar lavage is valuable in diagnosis of tuberculosis, infections and malignancies.
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